Zusammenfassung
Fragestellung
Bislang erhältliche winkelstabile Systeme am distalen Radius waren durch fest vorgegebene Verblockungsstellungen limitiert. Neuentwickelte multidirektionale winkelstabile Systeme am distalen Radius wurden entwickelt, um das extraartikuläre Einbringen der Schrauben zu ermöglichen und durch die Variabilität der Plattenlöcher eine zentrale und dorsale Abstützung der Gelenkfläche zu erreichen.
Methodik
In einer prospektiven Untersuchung wurden konsekutiv 20 Patienten mit Radiusextensionsfrakturen über einen standardisierten palmaren Zugang mit einem multidirektional über sphärische Keilverblockung des Schraubenkopfs winkelstabilen Implantat (APTUS/Medartis, Basel) unter Armplexusanästhesie versorgt. Die Patienten wurden bislang über 26 (23–28 Wochen) u. a. hinsichtlich Schmerz (visuelle Analogskala [VAS] 0–100), Funktion, Griffkraft, Krimmer-Score, DASH-Score (DASH Disability of the Hand, Shoulder and Arms) und radiologisch untersucht. Zudem wurden die Operateure bzgl. der Handhabung des Instrumentariums befragt. Als statistische Methoden wurden der χ2-Test sowie ANOVA in Verbindung mit dem Tukey-post-hoc-Test eingesetzt. Signifikanz wurde für p <0,05 angenommen.
Ergebnisse
Es wurde ein durchschnittlicher Bewegungsumfang für Extension/Flexion von 87° (76% der Gegenseite) und Ulnar-/Radialduktion von 42° (88%) erreicht. Die Patienten waren schmerzfrei bzw. schmerzarm (VAS 3 ohne, 24 unter Belastung). Die grobe Griffkraft betrug 84% der Gegenseite. Insgesamt mit der Behandlung zufrieden waren 82% der Patienten. Der durchschnittliche DASH-Score betrug 13. Im Krimmer-Score fand sich mit durchschnittlich 83±27 Punkten ein exzellentes Ergebnis. Die radiologisch dargestellte Ulnavarianz betrug 0,9±0,4 mm, die Radioulnarinklination 21±5° und die Palmarinklination 4±6°.
Schlussfolgerung
Unsere Daten zeigen, dass das Versorgungskonzept mit multidirektional winkelstabiler Osteosynthese am distalem Radius zuverlässig und effektiv ist. Jedoch sind prospektive Vergleiche mit den anderen etablierten Verfahren erforderlich, um den definitiven Stellenwert zu bestimmen.
Abstract
Background
The management of fractures of the distal radius continues to evolve. New operative strategies have recently been developed including the use of fixed-angle plates. This study reviews the results of 20 patients with fractures of the distal radius treated with a new multidirectional fixed angle plate.
Method and materials
A total of 20 patients with closed Colles type fractures of the distal radius were treated with Medartis (Aptus 2.5) palmar fixed-angle plates. Surgery was performed under plexus anesthesia using the standard or extended flexor carpi radialis (FCR) approach. Patients were evaluated prospectively with a mean follow-up of 26 weeks (range 23–28 weeks). Pain, range of motion, grip strength, DASH score, modified Mayo wrist score and radiographs were obtained. The level of significance was set at 95% and the χ2 and ANOVA tests in combination with a post hoc Tukey test were used for statistical analysis.
Results
The average range of motion (ROM) in extension-flexion was 87° (76% of the contralateral side) and in ulnar-radial deviation 42° (88% of the contralateral side). Pain values (visual analogue scale 0–100) at follow-up were 3 (without stress) and 24 (with stress). Grip strength improved to 84% of the contralateral side, the mean DASH score was 13 points and the modified Mayo wrist score confirmed the excellent results with a mean value of 83±27 points. Radiological examination showed a satisfactory result with an ulna variance of 0.9±0.4 mm, radio-ulnar inclination of 21±5° and palmar inclination of 4±6°.
Conclusions
Our data show that treating unstable distal radius fractures with multidirectional palmar fixed-angle plates is reliable and effective and produces good early functional and radiological results. However, long-term results with a larger number of patients and randomized prospective studies comparing this technique with other established procedures are required.
Literatur
Amadio PC (1997) Outcomes assessment in hand surgery. What’s new? Clin Plast Surg 1:191–194
Arora R, Lutz M, Zimmermann R et al (2007) Limits of palmar locking-plate osteosynthesis of unstable distal radius fractures. Handchir Mikrochir Plast Chir 1:34–41
Beyermann K, Prommersberger KJ (2000) Simultaneous management of multi-fragment distal radius fractures with palmar and dorsal approach. Handchir Mikrochir Plast Chir 6:404–410
Board T, Kocialkowski A, Andrew G (1999) Does Kapandji wiring help in older patients? A retrospective comparative review of displaced intra-articular distal radial fractures in patients over 55 years. Injury 10:663–669
Campbell DA (2000) Open reduction and internal fixation of intra articular and unstable fractures of the distal radius using the AO distal radius plate. J Hand Surg [Br] 6:528–534
Carter PR, Frederick HA, Laseter GF (1998) Open reduction and internal fixation of unstable distal radius fractures with a low-profile plate: a multicenter study of 73 fractures. J Hand Surg [Am] 2:300–307
Constantine KJ, Clawson MC, Stern PJ (2002) Volar neutralization plate fixation of dorsally displaced distal radius fractures. Orthopedics 2:125–128
Cooney WP, Bussey R, Dobyns JH, Linscheid RL (1987) Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 214:136–147
Figl M, Weninger P, Liska M et al (2009) Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 5:661–669
Gabl M, Pechlaner S, Sailer R, Friessnig P (1992) Dorsal compression fractures of the distal radius metaphysis. Long-term follow-up with conservative therapy. Akt Traumatol 1:15–18
Geissler WB, Fernandez DL (1991) Percutaneous and limited open reduction of the articular surface of the distal radius. J Orthop Trauma 3:255–264
Germann G, Wind G, Harth A (1999) The DASH (Disability of Arm-Shoulder-Hand) Questionnaire – a new instrument for evaluating upper extremity treatment outcome. Handchir Mikrochir Plast Chir 3:149–152
Hakimi M, Jungbluth P, Gehrmann S et al (2010) Unidirectional versus multidirectional palmar locking osteosynthesis of unstable distal radius fractures: comparative analysis with LDR 2.4 mm versus 2.7 mm matrix-Smartlock. Unfallchirurg 3:210–216
Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 6:602–608
Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg [Am] 5:647–659
Krimmer H, Pessenlehner C, Hasselbacher K et al (2004) Palmar fixed angle plating systems for instable distal radius fractures. Unfallchirurg 6:460–467
Krimmer H, Wiemer P, Kalb K (2000) Comparative outcome assessment of the wrist joint – mediocarpal partial arthrodesis and total arthrodesis. Handchir Mikrochir Plast Chir 6:369–374
Leung KS, Shen WY, Leung PC et al (1989) Ligamentotaxis and bone grafting for comminuted fractures of the distal radius. J Bone Joint Surg [Br] 5:838–842
Martini AK, Fromm B (1991) Secondary arthrosis of the wrist joint in malposition of healed and uncorrected distal radius fracture. Handchir Mikrochir Plast Chir 5:249–254
Mehling I, Meier M, Schlor U, Krimmer H (2007) Multidirectional palmar fixed-angle plate fixation for unstable distal radius fracture. Handchir Mikrochir Plast Chir 1:29–33
Meier R, Jansen H, Uhl M (2009) Radiological procedures in the traumatised wrist. Radiologe11:1063–1084
Meier R, Krettek C, Krimmer H (2003) Diagnostics at the wrist. Unfallchirurg 12:999–1009
Oestern HJ (2001) Behandlung der distalen Radiusfraktur. In: Schmit-Neuerburg KP, Towfigh H, Letsch R (Hrsg) Tscherne Unfallchirurgie: Ellenbogen, Unterarm, Hand. Springer, Berlin Heidelberg New York, S 225–247
Orbay JL, Fernandez DL (2002) Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg [Am] 2:205–215
Rikli DA, Regazzoni P (1996) Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases. J Bone Joint Surg [Br] 4:588–592
Ring D, Jupiter JB, Brennwald J et al (1997) Prospective multicenter trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg [Am] 5:777–784
Sakhaii M, Groenewold U, Klonz A, Reilmann H (2003) Results after palmar plate-osteosynthesis with angularly stable T-plate in 100 distal radius fractures: a prospective study. Unfallchirurg 4:272–280
Trumble TE, Schmitt SR, Vedder NB (1994) Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg [Am] 2:325–340
Zimmermann R, Gabl M, Lutz M et al (2003) Injectable calcium phosphate bone cement Norian SRS for the treatment of intra-articular compression fractures of the distal radius in osteoporotic women. Arch Orthop Trauma Surg 1:22–27
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Meier, R., Krettek, C. & Probst, C. Erste Ergebnisse der multidirektional-winkelstabilen palmaren Osteosynthese der distalen Radiusfraktur. Unfallchirurg 113, 789–795 (2010). https://doi.org/10.1007/s00113-010-1845-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00113-010-1845-1